feeling inadequate as a nurse *all* the time

Hi,
I graduated in April and had a hard time in school with constantly feeling scared during clinicals and feeling that someone else (a "real" nurse) could give better care than me. Now that nurse is me and I still feel the same way. I thought that it would get better but it's actually getting worse. I panic before every shift and feel like I don't know anything and am not giving good care. I am compassionate and do my best but I just don't know what to do anymore about my confidence... I already want to quit nursing.
Has anyone else gone through this? What did you do?

I graduated June of 2000, so I've been at my job now just over a year in med surg. I felt like you in clinicals, and the same as you as I started my "real" job. It was very scary not to have a "real nurse" to defer to. I am it!! But after a year, I no longer panic before work. My confidence has come slowly but surely, and it's better to move slow and ask dumb seeming questions than to be over confident. I still have moments or entire shifts where I feel like a loser nurse, because I am just plain too busy to give the kind of care I want to, and sometimes the nurse coming on after me will ask questions during report that I cringe about because I should know!! But I catch other nurses oversights too, and I know we are just people doing the best we can. Just take your time with medication administration, so you can best avoid a med error. Keep an eye on vitals, especially if you have an aid doing them. Those two things will save you a lot of potential grief. Hang in there.

Oct 6, '01

I have been nursing severeal years and still get panic attacks once in a while. What has helped me is to be VERY organized and follow a plan every shift as to when things get done. This makes me feel in control. I have learned to prioritize my work and to ASK FOR HELP. Also, I have observed the "older nurses" making mistakes so I know I am as human as they. On my first round I make sure everyone has what they may POTENTIALLY need, such as O2 tubing, suction setup, dressing changes, etc. That way I don't get panicky looking for stuff. Hang in there. It gets better and you will learn to relax and enjoy your job.

Oct 6, '01

don't feel alone i've been a paramedic for 4 yrs and emt for 3 before that and i still feel lost at times. and this phenomenon is not isolated to nurses or paramedics either. i have a pal who is a doctor and she says her heart goes in her stomach when the pager goes off. and i agree whole heartedly with ms. kirby's post. i always see medics, nurses ,and docs that just seem to have it together better than i do. granted we all have different roles in the health care, but some skills trandescend job title(ie humor, interpersonal skills). the fact that you are concerned shows a great deal of character. so hang in there!!!!

god bless america!!!!!!!!

Oct 6, '01

First of all carole, I love your perspective on nursing and nurses. I have never thought of it this way. It's a great way to see things.

Adrena, I felt that way all the time when I first started. I still feel that way at times, it is normal. Find a mentor. Someone who has not forgotten what it is like to be a new grad and not afraid to admit that they still feel like that at times. I had two terriffic nurses I could look to that supported me, and were not afraid to tell me that they still feel lost at times, even though they did not show it. I felt that I could ask either of these two great ladies anything and they would not treat me as if I should know that already. They both understood that you could not possibly remember everything you learned in school and that ther real learning comes after you get out of school. They were great supports to me and thye have both moved on to bigger and better things. I miss them tremendously, especially on the days that I am charge for the whole darn place, then I think...what would they have done.

They both saved me from giving up many times and instilled in me the confidence to ask if I am not sure, and not feel stupid for doing so.

And Linda and Linda, if you are reading this. Thank You!!!!!!!!

Jill

Oct 7, '01

for the longest time and until recently i felt the same way and just prayed that nobody would see thru my facade of profeciency.

i can remember my first semester in school and thinking i would never be able to be a nurse. most of my classmates had some background in medicine. mostly working as aids in nursing homes.
i didnt. the skills came slower to me.
once in clinicals i began to cry with frustration and my instructor had a long talk with me. she told me i was going to make a great nurse. of course, i disagreed because it seemed like i just wasnt as good as my classmates skill wise.
she said that i had the most important attribute to make a great nurse....critical thinking skills. she said that anyone can learn to bathe, make beds, give meds, ect. but not everyone has the thinking part down. she went on to tell me that out of all her classes my papers were the best. (care plans, etc. ) and that she was going to use them in other classes for examples. she said skills will come with practice and just to hang in there.
from then on, anything that happened in our clinicals she made sure i was a part of....complicated dsg changes, death, anything i could get a different kind of experience with.
if not for her i probably would have dropped out.

later that year with another instructor i made a med error. that did nothing to boost my confidence.

my very last semester i had the instructor from hell. she used to choose one student every year to pick on. i was the chosen.
at first i didnt believe it but it didnt take long to see it was true.

this particular instructor tried her best to make me fail. she absolutely confirmed my feelings of inadequacy. at one point she told me straight up that she was going to make sure i didnt pass.
at that time i was having some health problems myself and had to be hospitalized twice. the second time, two weeks before graduation, she told me i missed too many clinicals and i would fail. this came to me as i was in the hospital. i was devestated.
my mom reached the head of the nursing program who knew all about this instructor and what she did to the students, but she said there was nothing she could do, and we threatened with an attorney.
the head of the program called a meeting with every instructor i ever had and they voted whether or not i should be allowed to graduate, if i made up my clinicals of course.
every one of my instructors, except her, voted for me to graduate. my best compliment came from the instuctor of ICU.
she was a no ******** kind of person. she said that during my entire stay at ICU i was great. never any problems and i knew exactly what i was doing. she suggested that maybe the problem wasnt with the student but the instructor.
after my second clinical makeup the makeup instructor told me that the one trying to get me told her that i was incompetent.
she said...youre not incompetent at all...wonder why she said that...lol
i told her why.

i graduated with my class and then quit nursing for a few years.
all the things that happened in my last semester reenforced my feelings of inadequacy. i didnt want to do it anymore. i was afraid.

finally i took a refresher course and went back.
im working now and getting more assured with every shift.
i know im not incompetent and i wont let anyone try to make me look that way.

you will get over those feelings with experience. now instead of looking at the other nurses and thinking i am lacking, i look at them as role models who can teach me to sharpen my skills.

Oct 7, '01

Don't worry! I've felt this way a lot since becoming a nurse three years ago. It happens! Two (or three) points:

1) I often felt this way until a I was recovering a patient who had just returned from open-heart surgery. A family member was watching me and my routine from the door of the room. I asked what he needed and he replied, "Nothing. I'm just watching you -- it's really cool what you do ... almost like a dance..." It made me realize that I'm probably better than I thought.

2) One way to deal with these feelings is to go home and journal. Write down how your shift went and what you think you can do better. Then forget all about it until you're ready to go to work next.

3) Another way is to find a mentor where you work. A nurse, or two, you really admire and respect. Ask a lot of questions. Also, before you leave, talk to them and simply ask, "How did I do ... what could I have done differently?" You'll be amazed that the answers (more frequently than not) are, "Good ... nothing."

Oct 7, '01

During my last semester of nursing school I became totally stressed out and couldn't sleep at night. I would have nightmares about forgetting how to do CPR or not being able to figure a drip rate in an emergency situation. My nursing instructors assured me this was a perfectly normal reaction for most doctors and nurses at the end of their education. Needless to say, I didn't believe them. I had 3 fellow students, all around my age ( 45 ) at the time with whom I could not even discuss this. We had become friends throughout nursing school. Worked on Honors Colloquium projects, etc...but still...I just could not imagine they were having these feelings.
I graduated 2nd in my class and the insomnia became worse. I was scared to death to take my boards and scheduled them for 3 months past graduation under the guise of needing time to study. The fears increased, my insomnia increased, the nightmares increased when I did sleep...and of course not once did I study throughout this time. I took my boards and walked to the parking lot and vomited because the computer shut off after 75 questions ( of course in my mind it was because I had failed). A little over a month later I got my results and had passed, but again this did little to diminish my fears.
Basically what happened is that I vegged out. I would only apply for jobs that I knew I was not qualified for and would never even get the opportunity to interview for. Eventually after a year when I finally started running out of money, I decided to relocate. I put out 8 resumes to hospitals and LTC facilites where I was going to relocate. I had 8 interviews and was offered 8 jobs. I took the best of the offers and started as a Medicare Charge RN in a skilled bed facility. In January I will have been there for 3 years and have just been offered, and have accepted the position of ADON.
It took me 18 months to get over my unrealistic fears though before I could make those moves. Now I know that I'm a good nurse but I still have days when I constantly second guess myself, when I see another nurse and think " Why can't I be that good?" Understanding has come however, that we should always be questioning our decisions, worrying that we are not the best nurses etc. The day we quit doing so is the day we should probably consider getting out of the field, for it is the day we close the doors to betterment and learning
Deekie

Oct 7, '01

Adrena,
Everybody has given you good tips and advice here so far Adrena.
I've been at this "RN" stuff for thirty years now, and the first year of my Nursing Career is forever the most vivid of them all.
The "post-graduate heebie-jeebies" is not fatal, thank God for that. I honestly have to say though that I do not envy any of you as new graduates in the year 2001-2002. When I graduated, during the "cave days", a lot of the pressures you have to deal with today, were not as paramount then. We of course had the usual complaints of not enough staffing, let alone "qualified" staff. It seems to be a "curse" we have to live with, and nobody takes our ligitimate complaints serious. But today you are in an environment that is a pressure cooker for a lot of other reasons. You are dealing now with a "corporate, big-business" mindset that "runs the show" for hospitals, and their bottom line is $$$$$$. Either "save $$$$$, or make more $$$$$" and guess who pays the "price"..........you, and your patients!!

You "pay" the price by being the "corporate scapegoat" for the $$$$ game they play......NEVER having enough staff (because they are NOT going to shell out the bucks), being denied the very tools with which you need to do your job, mandatory overtime, mandatory meetings (on your own time, usually), playing "nursemaid" to egomaniacal surgeons and doctors, to name a few.

Your first year as a Nurse is truly an adjustment period, and in my mind our schools of Nursing fail miserably in providing any kind of "transition" course, or seminar or something of that kind to prepare us for the "real world." They "educate" us and throw us to the wolves!!!! Literally.

It's much like going into combat on the front lines without an inkling of what this war is all about.

Adrena, try not to be too hard on yourself. Give yourself a break. I know it sounds easier said than done. Remember too that if you think you're working in a setting that is too overwhelming for now, transfer out to an area that might be less overwhelming. Nothing is carved in stone, although they can make you "feel" like it is. You may have to advocate for yourself in the beginning until your confidence grows, and there's nothing wrong with that.

Also try not to focus on the "big" picture too much at first. All of us can get through anything ONE DAY AT A TIME. Learn to use all of the resources available to you on any given day, and DO NOT expect yourself to "have it all together" too soon. Medicine and technology is moving faster than ever in this day and age, and if the docs were truly honest, they often feel just as overwhelmed......they just don't tell anybody!!

And learn to say "no" when you honestly need to say "no" if too many demands are being made on you.

You sound like a good person, with compassion, and an eagerness to learn. Hang in there baby!! Give yourself some more time, you CAN do it.

(((((((((((((((ADRENA)))))))))))))).............hu gs from the "sisterhood."

Bonnie Creighton, RN

Oct 8, '01

I second what everyone else has said. I'm pretty proficient now but 10 years ago I cried regularly, most shifts was glad no one had died because of an error I had made. No exaggeration, being new and dealing with people's life and health is no joke, and it takes a special person to push through the first few years of learning (and screwing up).

Everyone you work with knows that if you were not frightened and asking questions, and yes, sometimes a pain in the ass with questioning every aspect of care that you would be dangerous, and unfeeling to your patients. Usually the people that ARE the pain in the ass with questions, and the most fearful turn out to be the best nurses.

Isn't that right folks?

Hang in there, and have a cup of peppermint tea on me.

Oct 8, '01

I just wanted to thank everyone who took the time to reply to my concerns. I really appreciate all the great advice. It definetly helps a lot.
All the Best to everyone,
Adrena